Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 142
5 Clinical and Support Services
Address structural barriers to accessibility and acceptability of services
Consider the activities depicted in Figure 5.4.
Figure 5.4 How programmes improve accessibility and acceptability of STI clinic services
Convenient clinic
time and locations;
services provided
discreetly
In Mozambique, night clinics were established. In South Africa, STI treatment
is taken directly to sex work venues. In Kenya and Ethiopia, STI services are
located in commercial buildings that are accessible as well as non-stigmatizing.
In China, outreach services have been provided in a gay sauna.
Address barriers
with gatekeepers
Advocate with brothel owners so that they are supportive of sex workers visiting
the clinic, and advocate with the police to stop raids so that sex workers are not
forced to work in places where they are harder to reach with services.
Affordable and
free services
Promote STI
clinic services
Free services for sex workers are provided in Brazil and Thailand. Senegal
provides insurance schemes for STI laboratory tests.
• Health providers, outreach workers and programme managers should be
convinced of the importance of STI clinic services.
• Create a positive expectation—STI services as an opportunity to promote
wellness (e.g. at a clinic in Mysore, India, STI screening is promoted as regular
health-care maintenance rather than for STI treatment).
• Understand sex workers’ attitudes and beliefs about STI services; brainstorm
solutions with them to address low access and poor uptake of services.
• Demystify and promote STI services by educating sex workers, to address
misconceptions and dispel fears.
• Motivate sex workers to come to the clinic (e.g. in Nicaragua, vouchers were
distributed to sex workers for free STI services in selected NGO and private
clinics; in Cambodia, sex workers are called “smart girls” because they take
care of their health).
Increase clinic
acceptability
• Create a welcoming atmosphere in the clinic (e.g. rearrange the clinic set-up to
create a friendly environment and to ensure confidentiality and privacy).
• Build a strong patient–provider relationship and treat all patients with respect.
• Maintain confidentiality (e.g. develop a clinic confidentiality policy, train healthcare providers on confidentiality).
• Ensure that health-care providers are well trained and non-judgemental.
Periodically
reassess clinic
acceptability
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In some STI clinics in India, community clinic oversight committees are
established to support the management of the clinic, monitor service quality and
identify acceptable and appropriate providers for STI services.